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Hydrocortisone therapy did not improve outcomes among patients with septic shock (onset within 72 hours), although it did shorten the duration of vasopressor dependence.
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Among patients with very early septic shock who were non-responders to a cosyntropin stim test, hydrocortisone/fludrocortisone therapy improved 28-day survival. Furthermore, steroid therapy reduced duration of vasopressor therapy in all patients (regardless of stim test response).
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Among critically ill patients, intensive glucose control increased 90-day mortality and the incidence of severe hypoglycemia compared to conventional therapy.
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In surgical ICU patients (primarily cardiac), intensive insulin therapy reduced ICU mortality, renal impairment, and bloodstream infections. The rate of severe hypoglycemia was higher with intensive insulin.
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In patients presenting within 3 hours of ischemic stroke, alteplase improved 3-month neurological function (NNT=9) but did not impact 24-hour symptoms or mortality. In patients receiving alteplase, approximately one-quarter had minor bleeding, and 6.4% had symptomatic ICH (NNH=17).
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Medical ICU patients receiving continuous infusion sedation with daily interruption were liberated from mechanical ventilation and left the ICU quicker, but this effect did not translate to a shorter hospital course or a mortality benefit.
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Early initiation of TPN increased ICU and hospital stay, the incidence of infection, and total healthcare costs. Delaying parenteral nutrition up to 7 days had no effect on mortality.
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Protocolized early goal-directed therapy initiated in the ED in severe sepsis and septic shock patients improved resuscitation parameters and reduced mortality.
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Among patients with all types of shock, mortality rates were not different between norepinephrine and dopamine, although norepinephrine was more effective as a vasopressor and was less associated with arrhythmias. Norepinephrine may have a mortality benefit over dopamine in a subset of patients with cardiogenic shock.
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The use of “renal dose” dopamine did not reduce peak creatinine, the need for renal replacement therapy, ICU length of stay, or mortality.
